12145 SW SUMMER CREST DRIVE-1 12145 :a SUMMER CREST DRIVE
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INSPECriori NOTICE
City of Tigard Buildioq Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639-4171
Type of Inspectif, i
Date Reqw-sted Time A.M. P.M.
Address - --_-1.2 sk Q10Permit
Owner Lot
Builder --A�)-fek 11 AfLIkE
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The followi,:q Building Code deficiencies we required to be corrected:
Pri,sented to Approved
Inspector
Disapproved
Date CC
CALL TOR REINSPECTION
YiEs rt Igo
SEWER PERMIT
3 i9 a
Unified Sewerage Agency
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of Washington County CITY C''= DAlt /�
OWNER : —_1%!_L. 0 QMhe — PHONE :� ti
OWNER 'S ADDRESS: _ SW41�'' 1D?SI ��E.
TYPE OF INSTALIATION:
/`-' SIDE SELVER ❑ LINE TAP AND SIDE SEV;ER ❑ LINE TAP
TYPE OF OCCUPANCY:
NEW [] EXISTING SINGLE FAMILY ❑ COMMERCIAL
EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UN 'TS— _ DWELLING ONiTS—
ADDRESS OF STRUCTURE : .�J wtrN�fM �`� , t"gve-
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling fo• inspection, please refer to the Permit Number. The Application eYNires in one hundred twenty (120)
days. The amount paid will be forfeited ,should expiration occur.
'rhe Agancy does not guarantee the accuracy of the location of side sewer laterals. If the fewer is not located at
the measurement given, the installer shall prospect three feet in all directions from the distance grid depth given.
If not so located, the Installer !.)all purchase a 'Tap and Side Sewer' Perm!, at the current charge and the Agency
will install a lateral at .e location specified by the installer.
FEESs
PERMIT FEE $ �m �• ��
CONNECTION CHARGE - �
LINE TAP INSTALLATION
ISS!!ED BY
�OT AL
APPLICANT ATF
SEWH PERPI., IT
tIDDRESS OF STRUCTUPE rZ �'�.� C�� 6=f (5II4f V .
TAX MAP � �� � e � TAX LOT clou-- SYSTEM
LOT 1—BLOCK O F
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APPROVED BY DATE ISSUED BY DA-1E:
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